Ensemble Health Partners

Director

• Ensures that Revenue Cycle goals, objectives, and vision are achieved
• Direct oversight of daily operations including management of managers, supervisors, and coders
• Integral in the development, implementation, and maintenance of efficient processes, coding compliance plan, and coding education for Ensemble and Clients

Director, Coding

Accounts Receivable

• Mentors AR Specialist team members to help develop and improve their skills in the denials and appeals process.
• Examines denied and other non-paid claims to determine reason for discrepancies.
• Demonstrates initiative in resolving complex claims and proactively makes recommendations to management on specific trends or necessary interventions.
• Communicates directly with payers to follow up on outstanding claims, files technical and clinical appeals, resolves payment variances, and ensures timely and accurate reimbursement.
• Provides guidance to other team members on resolving complex claims and filing appeals.
• Ability to identify with specific reason underpayments, denials, and cause of payment delay.
• Works with management to identify, trend, and address root causes of issues in the A/R.
• Takes meeting minutes for payor escalation calls and provides feedback to the AR associates key takeaways from the calls.
• Maintains a thorough understanding of federal and state regulations, as well as payer specific requirements and takes appropriate action accordingly.
• Documents all activity accurately including contact names, addresses, phone numbers, and other pertinent information in the client’s host system and/or appropriate tracking system.
• Demonstrates initiative and resourcefulness by making recommendations and communicating trends and issues to management.
• Reviews escalations from other areas to AR as well as accounts that require escalation to other areas of Revenue Cycle.
• Assists the supervisor with DIBS calls as needed.
• Needs to be a strong problem solver and critical thinker to resolve accounts.
• Must meet productivity and quality standards as established by Ensemble.

Senior Specialist, Accounts Receivable

Vice President

• Leadership Decision Making: Makes day-to-day leadership decisions by securing and comparing information from multiple sources to identify issues; commits to an action after weighing alternative solutions against important criteria; effectively communicates decisions to the appropriate people and teams and holds them accountable.
• Coaching & Building Talent: Achieves results through other leaders by empowering them and providing feedback, instruction and development (coaching the coach) to develop their own associates; plans and supports the growth of individual skills and abilities in preparation for their next role (building bench); focuses on retention of high performers.
• Delegation: Successfully shares authority and responsibilities with others to move decision making and accountability downward through the organization while accomplishing strategic priorities; maintains personal ownership of outcomes without excessive involvement.
• Leading Teams : Inspires and sustains team unity and engagement by developing, motivating, and guiding the team to achieve results together through productive relationships and work.
• Executive Communication: Clearly and succinctly conveys information and ideas; communicates in a focused and compelling way that captures and holds others’ attention.
• Program/Project Management: Demonstrates high accountability and responsibility for projects and programs from inception through completion/implementation; manages budget and resource planning and awareness to ensure maximized output, reduced waste and exceptional results.
• Serves as a strategic partner to senior executives and operational leaders to align data, analytics, and AI capabilities to organizational priorities.
• Builds, leads, and mentors a high-performing team; establishes departmental goals and objectives, evaluates performance, and fosters professional development and succession planning.
• Establishes service excellence standards and accountability measures; ensures consistent delivery of trusted, timely, and high-impact analytics solutions to stakeholders throughout the organization.

VP, Net Patient Revenue Analytics

Operations

• Follow up on patient accounts with a self-pay balance
• Print and mail medical records, itemized bills, and required documents
• Review patient accounts for errors
• Collaborate with other departments on patient complaints

Self Pay Operations Specialist II

• Responsible for duties necessary to follow up on patient accounts with a self-pay balance for the assigned client(s).
• Perform functions while meeting the mission of Ensemble Health Partners and all regulatory compliance requirements.
• Work within the policies and processes performed across the entire organization.
• Provide patient-related activities including printing and mailing medical records, itemized bills, and other required documents.
• Provide daily volume, backlog and workflow information.

Associate Self Pay Operations Specialist

Medical Billing and Coding

• Reviews medical record documentation and accurately assigns appropriate ICD-9-CM, ICD-10, CPT IV, and HCPCS codes utilizing the 3M software tools for all OP Work Types
• The assigned codes must support the reason for the visit and the medical necessity that is documented by the provider to support the care provided
• When applicable, applies the appropriate charges such as the Evaluation & Management (E&M) level and injections and infusions and/or other necessary requirements for Observation cases, using third-party software systems such as LYNX
• Correctly abstracts required data per facility specifications
• Performs "medical necessity checks" for Medicare and other payers as required per payment guidelines
• Responsible for monitoring and working of accounts that are Discharged Not Final Billed, failed claims, stop bills, and epremis as a team, ensuring timely, compliant processing of outpatient claims in the billing system
• Maintains established productivity requirements, key performance indicators established for 3M 360 CAC for CRS & Direct Code as well as ensures accuracy to maintain established quality standards
• Remains abreast of current requirements of the Centers for Medicare & Medicaid Services (CMS) to include National Coverage Determinations (NCD) and Local Coverage Determinations (LCD) guidelines, related to the assignment of modifiers, to ensure the submission of a clean claim the first time through
• Maintains competency and accuracy while utilizing tools of the trade, such as the 3M encoder, Computerized Assisted Coding (CAC) Medical Necessity software, abstracting system, code books, and all reference materials
• Reports inaccuracies found in Coding Software to HIM Management/Supervisor, reports any potential unethical and/or fraudulent activity per compliance policy
• Attends required system, hospital, and departmental meetings and educational sessions as established by leadership, as well as completion of required annual learning programs to ensure continued education and growth

Medical Coding Specialist

Engineer

• Develop, test, and maintain software applications using C#, .NET Core, and Rest API technologies.
• Development and strong testing experience in unit testing, Integration testing and end to end tests and UI automation.
• Collaborate with front-end developers to integrate server-side logic with responsive UI designs using JavaScript and React.
• Deploy applications to the Azure cloud platform, ensuring scalability, performance, and security.
• Implement Continuous Integration and Continuous Deployment (CI/CD) practices to streamline software delivery processes.
• Participate in code reviews, identify areas for improvement, and propose solutions to enhance application performance and code quality.
• Collaborate with cross-functional teams to gather requirements, analyze user needs, and propose technical solutions.

Engineer II, Software

Project Manager

• Consistently provide exceptional experiences for our clients, patients, and colleagues by understanding their needs and exceeding their expectations.
• Continuously innovate by embracing emerging technology and fostering a culture of creativity and experimentation.
• Execute at a high level by demonstrating our “Best in KLAS” Principles and consistently delivering outstanding results.
• Perform Project Management functions aligned with the PMO best practices for technology, client, vendor, strategic projects and others as needed.
• Lead project teams through initiation, planning, executing/monitoring and controlling, and closing of designated projects with support from other Project Leaders in the PMO.
• Ensure project work is well-defined and planned.
• Ensure effective risk, issue, action, and change management.
• Establish, maintain and execute an effective communications plan serving all stakeholder needs.
• Monitor and manage project performance inclusive of cost and team performance.
• Manage changes to the project scope, project schedule and project costs using appropriate verification techniques.

Project Manager II

IT Support

• Interviews uninsured/under-insured patients to determine eligibility for a state Medicaid benefit or Financial Assistance program.
• Assists with application processes to facilitate accurate and appropriate submissions.
• Follows-up on submitted applications to ensure timely billing or adjustment processing.
• Reviewing all referred uninsured/under-insured patients for program eligibility opportunities.
• Effectively communicating with the patient to obtain documents that must accompany the application.
• Following submitted applications to determination point, updating applicable insurance information and ensuring timely billing or adjustment posting.
• Documenting all relevant actions and communication steps in assigned patient accounting systems.
• Maintaining working knowledge of all state and federal program requirements; sharing information with colleagues and supervisors.
• Developing and maintaining proactive working relationship with county/state/federal Medicaid caseworker partners and collaborating with other revenue cycle departments and associates.

Public Benefit Specialist

Manager

• Support, direct, and facilitate all aspects of the Patient Experience strategy
• Partner with site leaders and maintain accountability relationships with EHP leaders
• Conduct regular data analysis and reporting to Ensemble and client leaders
• Implement and execute evidence-based practices to improve patient/family experiences
• Provide professional coaching and consultation to influence stakeholders
• Create and oversee Patient Family Advisory Committee(s)
• Collaborate with leadership to mitigate barriers from patient complaints
• Analyze customer satisfaction metrics and implement action plans
• Prepare and present reports to stakeholders and leadership

Patient Experience Regional Manager

Insurance

• The Insurance Authorization Specialist is responsible for performing insurance authorization for all patients scheduled for services.
• Work within the policies and processes as they are being performed across the entire organization.
• Selecting accurate medical records for patient safety and working with insurance companies and/or physician offices to complete insurance authorization requirements to secure payment.
• Identify appropriate clinical records and submit authorization requests to the insurance company based on plan requirements for approval.
• Serve as the liaison between the ordering physician and insurance company to ensure requirements to secure approval are identified and communicated.

Insurance Authorization Specialist

Billing Specialist

• Support the Director, Revenue Cycle in the selection, direction and development of the billing department team members
• Report to the Director, Revenue Cycle
• Assist team members with problematic bills and questions regarding billing processes and best practices
• Responsible for direct oversight of a team of associates and supervisors with all decision-making regarding hiring, onboarding, training and performance management
• Manage the daily workflow of the department, monitor progress to identify trending issues and develop training or processes to address these issues
• Oversee progress and monitoring of worked accounts for quality assurance and productivity measures
• Assist in strategic planning and perform ongoing process improvement evaluation
• Review, update and implement policies and procedures to support the vision and goals

Billing Manager

Events

• Performing admitting duties for all patients admitted for services at the hospital
• Assigning accurate MRNs
• Completing medical necessity/compliance checks
• Providing proper patient instructions
• Collecting insurance information
• Processing physician orders
• Conducting audits of accounts
• Pre-registration of patient accounts prior to patient visits

Patient Access Specialist

Counselor

• Perform the task of benefit education and validation
• Handle the accurate verification and calculation of patient liabilities
• Make at least 3 attempts each day to visit a patient's room if preoccupied in previous attempts
• Assist in facilitating daily inhouse call reviews to validate that patients have a valid payor source
• Monitor missed collection opportunities for potential process improvements and follow-up

Financial Counselor

• Code claims directly from the medical record/operative report according to coding guidelines.
• Accurate and timely completion of work queues as assigned.
• Track and identify trends within charge review and follow up work queues and assist leadership in the resolution of those trends and/or educational needs.
• Assists with research of denied claims.
• Maintains compliance with established corporate and departmental policies and procedures, quality improvement program, customer service and productivity expectations.
• Must be able to achieve individual quality and productivity performance metrics in daily duties as set by coding leadership.
• Provide and/or assist with provider education, as well as the development of educational tools.
• Communicates professionally with physicians, management, and peers.
• Participates in all educational activities including coding meetings/calls necessary to provide information relating to coding and compliance.
• Remains abreast of changes to current payer guidelines, Correct Coding Initiative edits, and Local/National Coverage Determinations for accuracy in Coding and mentors team members regarding coding guidelines and accuracy.
• Assists with training of other coders.
• Takes initiative for learning new skills and willingness to participate and share expertise on projects, committees and other activities as deemed appropriate.
• Demonstrates personal responsibility for job performance.
• Extensive knowledge/experience in physician coding with expert knowledge in a specific coding specialty and the ability to provide education/support to coding team and providers.